The Role Of Cognitive Impairment In The Use Of The Diskus Inhaler

Background and Objectives:

Approximately 1.6 million geriatric nursing home (NH) residents are living in about 17,000 Nursing Homes in the United States. This population (including those who live in Assisted Living Facilities [ALFs]) will increase significantly over the next 20 years as the "Baby Boomers" enter this age group. Associated with this will be an increasing number of cognitively impaired individuals with Chronic Obstructive Pulmonary Disease (COPD). As a nation, we will need to find effective and efficient means of caring for this growing population.

Sometimes there is an "intuitive anecdote"; a belief that mildly to moderately cognitively impaired individuals (score of 10 to 24 on the Mini Mental State Exam [MMSE]) are unable to synthesize and execute the instructions necessary for the successful use of the Diskus Inhaler for COPD. We propose a controlled assessment of DISKUS Inhaler use in mildly to moderately cognitively impaired residents living in NHs and ALFs.

The Diskus Inhaler is administered by a nurse or medical technician in the NH setting. The administration of the medication from the Diskus Inhaler includes 4 steps: open, click, inhale, close. The only step that the resident must do is the "inhale" step, which includes holding one's breath for 10 seconds after the inhalation.

We propose that properly trained and motivated nurses and medical technicians can successfully administer medication using the Advair Diskus to almost any mildly to moderately cognitively impaired resident who can follow the instruction- "inhale" and hold your breath for 10 seconds". The objective is to show that mild to moderate cognitive impairment should not be a barrier to the use of Diskus Inhaler.